This proposal is centered around three main objectives: 1) Improve access to existing clinical information by rural healthcare providers; 2) Improve communications between primary care providers and specialists; and 3) Lay the foundation for a regional network that supports information sharing among rural hospitals and providers and creates an environment that encourages the adoption of health information technology (HIT). Access to information is often cited as a barrier to delivery of quality healthcare. The often fragmented nature of the healthcare delivery system is particularly challenging in rural America where distance and geography can be barriers to expert services. Adoption of HIT could be a significant factor in improving care by providing more timely and accurate information and by facilitating communications among providers and between physicians and their patients. Yet, adoption of systems such as electronic health records (EHRs) remains relatively low due to factors such as cost, culture, technical expertise and regulatory concerns. Geisinger Health System (GHS), an integrated delivery system with over 600 physicians and 40 clinics, has invested significant time and money implementing a full-function EHR for its providers and patients, and has experienced first-hand the transforming effects it has on coordination and quality of care. In order to take the next step and extend HIT solutions more globally to local hospitals and physicians, a different more incremental approach is required. Funding and IT expertise are major barriers for small rural hospitals and physician practices. GHS along with two local hospitals have developed a set of initiatives designed to accomplish the three objectives cited above primarily by leveraging HIT investment already made to provide incremental but important functionality that supports wider access to information, communications, and demonstration of the value of HIT. This approach will lead to sustainable regional solutions, inform future HIT efforts by small rural hospitals and physician practices, and add to the general knowledge regarding cost effective ways of sharing information using standards-based approaches. Rural populations face many barriers to access to high quality care. HIT is a solution to many of them, but cannot be adopted unless implementation is affordable. Accomplishing the goals of this proposal will mean more effective triage in rural emergency departments, better informed clinicians, and better coordination and higher quality of care. [unreadable] [unreadable]